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General NPI Number Information
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NPI Number | 1740005321
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Entity Type | Organization
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Legal Business Name | DW DENTAL LLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 3549 11TH AVE
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-5641
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Country | US
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Telephone | 712-328-0708
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Fax | 712-328-8991
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Provider Business Mailing Address
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Address Line | 3549 11TH AVE
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-5641
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Country | US
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Telephone | 712-328-0708
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Fax | 712-328-8991
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Authorized Official
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Title or Position | OWNER
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Name | DR. DILLON TYLER WOODS
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Credential | DDS
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Telephone | 402-669-7536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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